Hospital Information Systems

As technology becomes an ever-increasing driver to ensuring a smooth and efficient healthcare environment, a well-run collaboration can hold the key to success.

It is well known that most hospitals, regardless of size, deploy some type of digital imaging. As medical imaging continues to advance, hospitals must deal with the significant increase in data that is acquired and must be managed. Accordingly, almost all facilities are in one of three stages: leveraging a complete digital picture archiving and communication systems (PACS) solution, in the midst of deploying a digital PACS solution, or considering moving to a complete digital PACS solution. Therefore all hospitals are either implementing, have implemented, or are contemplating the implementation of a PACS solution that will enable their facility to efficiently manage complicated issues from large volume data storage to image distribution, work-flow efficiency, scalability and disaster recovery in a fiscally manageable way. Complicating the matter, many institutions necessitate a system that can manage all of these issues over multiple work sites with seamless coordination between clinical and information technology staff.

Two camps have developed regarding the management of hospital PACS: those who see PACS as the sole domain of the enterprise IT department, much like an e-mail server system; and those who see a PACS solution as a clinical application necessitating a dedicated radiology informatics department staffed with specialized individuals with a combination of clinical experience and information technology know-how. Some might even say that there is a rift between the two camps — a struggle for soul of the imaging suite.

Both camps make a strong case, but there may be a middle ground. An innovative model has begun to take hold which is exemplified by Baptist Health's approach to PACS management. Baptist Health has a few specially trained radiology informatics (RI) professionals with the strong clinical experience needed for understanding measures of advanced clinical decision support, meticulous hospital data presentation, and liaising with multiple medical staff at various locations. At the same time, the team has finely tuned knowledge of image storage, retrieval, management and distribution essential to maximizing the advanced visualization capabilities of our PACS solution. But far from a stand-alone department, these professionals rely extensively on the traditional IT department's enterprise knowledge in many important ways.

Two camps have developed regarding the management of hospital PACS: those who see PACS as the sole domain of the enterprise IT department, and those who see it as a clinical application necessitating a dedicated radiology informatics department.

At Baptist Health the general rule of operation is: The data center to the wall outlet belongs to IT; RI takes over from there. Make no mistake; the IT department maintains the integrity of the ever-important network and HIS systems. Even the Philips iVault PACS server is located in the IT data center, along with other informatics system servers. Like most facilities, IT has historically housed an array of servers and maintains a secure area for this purpose. Baptist has found no compelling reason to spend dollars and effort mimicking a well-functioning pre-existing system.

Consequently, seamless coordination between IT and RI is essential to a successful partnership, and relationship building and project management abilities are of the utmost importance when building a successful RI department. While the ideal RI specialist is a computer-savvy individual with a substantial clinical background who appreciates how complicated medical systems and clinical functions interact, essential supporting roles are often played by those with computer or systems backgrounds; they are the bridge to a successful partnership with the IT department. For instance, one top informatics engineer came from a local electronics retailer. His background in repair and system analysis was a perfect complement for the clinical leadership in the RI department.

It is this unique mix of talents that enables the RI department to bridge the clinical and traditional enterprise IT worlds by creating an atmosphere of clinician-focused communication that facilitates a more-efficient radiology practice.

The coordination of harmonious IT and RI departments may seem like a delicate balance; however, when the IT and RI teams worked together on their first significant integration (the Winscribe integration into iSite suite), the close cooperation required to complete the project cemented a firm partnership that has paid significant dividends to the organization as a whole.

As technology becomes an ever-increasing driver to ensuring a smooth and efficient healthcare environment, a well-run collaboration such as this can hold the key to success.

Baptist Health further maximizes efficiencies by utilizing the offsite data storage available through the Philips iSite PACS solution which accelerates image access, incorporates clinical applications with proven advanced clinical decision-support solutions, provides back-up studies for disaster-recovery purposes and prevents any unnecessary downtime — even as demand for imaging services grows over multiple work sites, including freestanding independent clinical partners. Again, it is the RI specialists who liaise with the Philips iSite service team whenever there is a need, freeing the core IT staff to manage all non-clinical enterprise needs.

Also of great importance to the institution is the seamless interface between radiology and cardiology PACS solutions, Philips iSite and Philips Xcelera respectively. Baptist Health was one of the first medical facilities to implement such an approach, which is scalable and flexible enough to grow over multiple sites. This ultimately benefits patients by facilitating physician access to all radiology and cardiology images and making related diagnostic information easily accessible anywhere throughout the Baptist Health PACS environment during office or hospital visits.

Those hospitals with early generation PACS solutions unable to handle the large data sets essential to clinically relevant visualization may also find that their systems are not adequate for broad image management or ideal for facilitating advanced clinical decision making. These common scenarios will almost certainly lead to excessive downtime, continual complaints and frustration, reduced quality of care, and the endless expense of hardware and software upgrades.

As previously mentioned, the Winscribe integration has paid tremendous dividends for the organization. Before this integration, like many health facilities Baptist utilized a legacy product that was in need of a substantial and expensive upgrade. It was slow, cumbersome to use and outdated; turnaround times were approximately four to 12 hours to get a report to a referring doctor. Post integration, radiologists enjoy a single sign-on for both systems simultaneously and our turnaround time is measured in minutes instead of hours. Our referring docs are extremely happy with this solution, which has also helped us grow from our original PACS footprint, three hospitals and six imaging centers, to four additional imaging centers and a growing teleradiology system — and we have plans for further expansion.

As hospitals around the world continue to implement digital imaging, many will find that integrated PACS solutions managed through a robust collaboration between RI specialists and traditional IT will rise to the top in terms of efficiency, ease of use and improved quality of care. The PACS solution itself is the foundation for success.